Diagnosis and laparoscopic excision of accessory cavitated uterine mass in a young woman:A case report

BACKGROUND Accessory and cavitated uterine mass(ACUM)is an uncommon form of connate Müllerian anomaly seen in young and nulliparous women,which presents as chronic periodic pelvic pain and severe dysmenorrhea.The entity is often underdiagnosed due to a broad differential diagnosis,including rudimentary uterine horn,true cavitated adenomyosis and degenerating fibroids.CASE SUMMARY A 22-year-old woman who presented with severe dysmenorrhea and was initially misdiagnosed with cystic adenomyosis.Gynecological examination and ultrasonography were performed.The patient underwent laparoscopic excision of the mass and histopathological examination confirmed the diagnosis.Postoperatively,the patient did well,with no further dysmenorrhea.CONCLUSION ACUM is difficult to diagnose.A correct diagnosis can be made only after excision and histopathological evaluation.Surgical excision is necessary and can be carried out by laparoscopy.

Risk factors for perioperative complications in laparoscopic surgeries of retrorectal cystic lesions

BACKGROUNDThe incidence of retrorectal lesions is low, and no consensus has been reachedregarding the most optimal surgical approach. Laparoscopic approach has theadvantage of minimally invasive. The risk factors influencing perioperativecomplications of laparoscopic surgery are rarely discussed.AIMTo investigate the risk factors for perioperative complications in laparoscopicsurgeries of retrorectal cystic lesions.METHODSWe retrospectively reviewed the medical records of patients who underwentlaparoscopic excision of retrorectal cystic lesions between August 2012 and May2020 at our hospital. All surgeries were performed in the general surgerydepartment. Patients were divided into groups based on the lesion location anddiameter. We analysed the risk factors like type 2 diabetes mellitus, hypertension,the history of abdominal surgery, previous treatment, clinical manifestation,operation duration, blood loss, perioperative complications, and readmission ratewithin 90 d retrospectively.RESULTSSevere perioperative complications occurred in seven patients. Prophylactictransverse colostomy was performed in four patients with suspected rectal injury.Two patients underwent puncture drainage due to postoperative pelvic infection.One patient underwent debridement in the operating room due to incisioninfection. The massive-lesion group had a significantly longer surgery duration,higher blood loss, higher incidence of perioperative complications, and higherreadmission rate within 90 d (P < 0.05). Univariate analysis, multivariate analysis,and logistic regression showed that lesion diameter was an independent riskfactor for the development of perioperative complications in patients whounderwent laparoscopic excision of retrorectal cystic lesions.CONCLUSIONThe diameter of the lesion is an independent risk factor for perioperative complicationsin patients who undergo laparoscopic excision of retrorectal cystic lesions.The location of the lesion was not a determining factor of the surgical approach.Laparoscopic surgery is minimally invasive, high-resolution, and flexible, and itsuse in retrorectal cystic lesions is safe and feasible, also for lesions below the S3level.

Extralevator abdominoperineal excision for advanced low rectal cancer:Where to go

Since its introduction,extralevator abdominoperineal excision(ELAPE)in the prone position has gained significant attention and recognition as an important surgical procedure for the treatment of advanced low rectal cancer.Most studies suggest that because of adequate resection and precise anatomy,ELAPE could decrease the rate of positive circumferential resection margins,intraoperative perforation,and may further decrease local recurrence rate and improve survival.Some studies show that extensive resection of pelvic floor tissue may increase the incidence of wound complications and urogenital dysfunction.Laparoscopic/robotic ELAPE and trans-perineal minimally invasive approach allow patients to be operated in the lithotomy position,which has advantages of excellent operative view,precise dissection and reduced postoperative complications.Pelvic floor reconstruction with biological mesh could significantly reduce wound complications and the duration of hospitalization.The proposal of individualized ELAPE could further reduce the occurrence of postoperative urogenital dysfunction and chronic perianal pain.The ELAPE procedure emphasizes precise anatomy and conforms to the principle of radical resection of tumors,which is a milestone operation for the treatment of advanced low rectal cancer.

Transanal minimally invasive surgery using laparoscopic instruments of the rectum:A review

Transanal minimally invasive surgery(TAMIS)was first described in 2010 as an alternative to transanal endoscopic microsurgery(TEM).The TAMIS technique can be access to the proximal and mid-rectum for resection of benign and earlystage malignant rectal lesions and also used for noncurative intent surgery of more advanced lesions in patients who are not candidates for radical surgery.TAMIS has a shorter learning curve,reduced device setup time,flexibility in instrument use,and versatility in application than TEM.Also,TAMIS shows similar results in a view of the operation time,conversion rate,reoperation rate,and complication to TEM.For these reasons,TAMIS is an easily accessible,technically feasible,and cost-effective alternative to TEM.Overall,TAMIS has enabled the performance of high-quality local excision of rectal lesions by many colorectal surgeons.As TAMIS becomes more broadly utilized such as pelvic abscess drainage,rectal stenosis,and treatment of anastomotic dehiscence,the acquisition of appropriate training must be ensured,and the continued assessment and assurance of outcome must be maintained.